NAME: Montalban, Kimberly N. YR.

& SECTION: 3RD YR- MED21B DATE: DECEMBER 14, 2023

SPECIFIC CLINICAL ENZYMES

1. ALKALINE PHOSPHATASE (ALP)

Methods/Assay
ISOENZYME ORGAN/ TISSUE SOURCE (per + Diseases present if the enzyme is Diseases present if the
REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay ELEVATED enzyme is DECREASE
and its End

ALP 1 Liver- Bowers & Mc Comb Osteoblastic bone tumors After blood transfusion
ALP 2 Bone - continuous-monitoring Hepatitis Malnutrition
ALP 3 Placenta technique Cirrhosis Hypophosphatemia
ALP 4 Intestine - Specific method Rickets Zinc deficiency
Reax’n; Osteomalcia
Obstructive Jaundice 30-90 /L
Diabetes
Renal failute
*requires

2. ACID PHOSPHATASE (ACP)

Methods/Assay
ISOENZYME ORGAN/ TISSUE SOURCE (per + Diseases present if the enzyme is
Additional REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay ELEVATED
and its End

Band 1 Prostate (Major source) (band 1) Gutman and Gutman: Moderate elevations: Tartrate-Inhibited ACP Total ACP MALE:
Band 2 RBC (band 3; band 2&4- - Phenyl PO4 —> Inorganic Female Breast CA (Prostatic isoenzyme) 2.5-11.7 U/L
Band 3 granulocytes) PO4 Paget’s Disease - For prostatic Prostatic ACP
Band 4 Platelets (Band 3) Shinowara Hyperthyroidism CA 0-3.5 ng/mL
Band 5 Osteoclasts (band 5) - PNPP—> P-nitrophenol Non-prostatic ACP elevations: - Medico-legal
Babson, Read and Phillips Niemann-Pick Disease cases
- Alpha-naphthyl PO4 —> Gaucher’s Disease (POSITIVE
Alpha-naphthol Myelocytic Leukemia ACP is evident
Roy and Hillman in vaginal swab
- Thymolphthalein monoPO4 if semen is
—> Free Thymolphthalein present for the
first 12hrs up to
4 days from
incident).
Tartrate-resistant ACP

1
 (Bone isoenzyme)
- Active
osteoclast-
mediated bone
resorption
- Gaucher’s cells
- Hairy cell
leukemia
Diagnostic significance:
- Detection of
prostatic CA.

3. ALANINE AMINOTRANSFERASE (ALT)/ (SGPT)

Methods/Assay
ISOENZYME ORGAN/ TISSUE SOURCE (per + Diseases present if the enzyme is
Additional REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay ELEVATED
and its End

Liver (highest concentration) Coupled Enzymatic reaction Acute or chronic VIRAL hepatitis Monitors the course of
Kidney - pH 7.5; 340nm Hepatic injury hepatitis treatment and
Pancreas Reitmann-Frankel Method Muscle injury effect of drug therapy
RBC - uses lactate dehydrogenase Kidney infarcts
Heart Reax’n: Renal Failure 6-37 U/L
Skeletal muscles Alanine + a-ketoglutarate <—ALT—>
Lungs pyruvate + glutamate
Pyruvate + NAD +H <—LD—>
lactate + NAD

4. ASPARTATE AMINOTRANSFERASE (AST)/ (SGOT)

Methods/Assay
Diseases present if the enzyme is
ISOENZYME ORGAN/ TISSUE SOURCE (per + Diseases present if the
ELEVATED REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay enzyme is DECREASED
and its End
Cardiac tissue Karmen Method Myocardial infarction Pregnancy
Liver - Uses malate dehydrogenase Hepatocellular disease
Skeletal muscles Reax’n: Skeletal muscle involvement
c-AST (cytoplasm)
Kidney Aspartate + a-ketoglutarate Diagnosis of Alcohol abuse & drug abuse
m-AST 5-37 U/L
Pancreas <—(AST)—> oxaloacetate + Pulmunary infection
(mitochondrial)
RBC glutamate Pericarditis
Oxaloacetate + NAD+H <—MD—> Acute Hepatitis
Malate + NAD
5. CREATINE KINASE (CK)
Methods/Assay
Diseases present if the enzyme is
ISOENZYME ORGAN/ TISSUE SOURCE (per +
ELEVATED Additional REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay
and its End
CK-1 (CK-BB) – Brain (BB) Tanzer-Gilvarg Assay Acute myocardial infarction (AMI) (CK- *Electrophoresis – method Male:
most rapid moving Smooth and skeletal muscles - Forward/ direct method MB) of choice and seldom used. 15-160 U/L

2
 CK2 (CK-MB) - Reax’n: Duchenne’s Muscular Dystrophy *Mass immunoassay- most Female:
hybrid CK1- brain Creatine + ATP <—CPK—> Creatine - highest elevation of total CK commonly used for 15-130 U/L
CK3 (CK-MM) – CK2- skeletal PO4 +ADP - skeletal muscle measuring CK-MB. CK-MB:
slowest and most CK3- SMOOTH (heart) MUSCLE) ADP+ Phosphoenopyruvate <—PK— Poliomyelitis “conan” monoclonal Ab- <6% of total CK
common >Pyruvate + ATP Acute Myopathy specific for CK-MB
Macro-CK Serum specimen using oxalate and Pyruvate + NADH <—LD—> Lactate Delirium tremens *CK is light sensitive
(mitochondria) fluoride anticoagulants (inhibits CK + NAD Hypothyroidism *(immunoinhibition assay)
action). Malignant hyperthermia
Oliver-Rosalki Method: Trichinosis and dermatomyositis
- Reverse/indirect method Acute cerebrovascular disease (Stroke)
- Most commonly used and Exercise
FASTER reaction Intramuscular injection
Reax’n:
Creatine PO4 + ADP <—CPK—> CK-BB increased:
Creatine + ATP Smooth muscle injury (intestinal ischemia)
ATP + Glucose <—HK—> ADP + Prostate CA
G6PO4 Small cell Carcinoma of the lung
G6PO4 + NADP <—G6PD—> 6- Intestinal malignancies
phosphogluconate + NADPH
Macro-CK2 present :
Myocardial Infarction (usually associated
with poor prognosis)
malignancies

6. LACTATE DEHYDROGENASE (LD)

Methods/Assay
Diseases present if the enzyme is
ISOENZYME ORGAN/ TISSUE SOURCE (per +
ELEVATED Additional REFERENCE VALUES
FORMS isoenzyme, if present) Enzymatic Reaction/Pinciple of Assay
and its End
Heart, Rbc, Kidney (LD1) Wacker method Viral hepatitis and Cirrhosis (2-3x LD1 & LD2
Lungs ,Pancreas, Spleen (LD3) - Forward / direct reaction increased) - FLIPPED Forward reaction:
Skeletal muscles, Liver, Intestine Lactate + NAD <—LD—> Pyruvate + Acute Viral Hepatitis (LD5 moderate) PATTERN in 100-225 U/L
(LD4 & LD5) NADH at 340nm Hepatic carcinoma and toxic hepatitis Myocardial Reverse Reaction
- (LD5 markedly increased/ 10 infarction and 80-280 U/L
Wroblewski La Due fold increase) Hemolytic
LD1 (H4) - Reverse/ indirect reaction anemia
LD2 (H3M) Pyruvate + NADH <—LD—> Lactate HIGHEST LEVEL IN: LD2 always higher than
LD3 (H2M2) + NAD Pernicious anemia LD1
LD4 (HM3) Hemolytic disorders
LD5 (M4)

7. AMYLASE / DIASTASE
Diseases present if the enzyme is
ISOENZYME ORGAN/ TISSUE SOURCE (per
Methods/Assay ELEVATED Additional REFERENCE VALUES
FORMS isoenzyme, if present)

3
 Pancreas Saccharogenic Acute pancreatitis -earliest pancreatic marker
saliva - measures the amount of - Smallest enzyme
reducing sugars produced
by the hydrolysis of starch
Amyloclastic
- amylase activity is
evaluated by following the
decrease in substrate
concentration
S-type (ptyalin) 60-180 SU/dL (Somogyi Units)
Chromogenic
P-type (amylopsin) 95-290 U/L
- measures the increasing
color from production of
product coupled with a
chromogenic dye
Continuous Monitoring
- coupling of several enzyme
systems to monitor amylase
activity

8. GAMMA-GLUTAMYL TRANSFERASE (GGT)

ORGAN/ TISSUE SOURCE (per
isoenzyme, if present)
-Evaluation of liver Liver
injury Canaliculi cells
- test for alcoholic Proximal renal tubule
abuse Intestinal Epithelium
Prostate gland
Methods/Assay
+ Diseases present if the
Enzymatic Reaction/Pinciple of Assay
and its End
Szasz Assay
- GGT is measured by
cleavage of Chromogen o-
carboxyl p-` from a
glutamate modified form of
the compound
Diseases present if the enzyme is
ELEVATED REFERENCE VALUES
enzyme is DECREASED
Liver – Major source of GGT release. Pregnancy (first trimester- Male:
Smoking (moderate-10% increase; heavy- 25% decrease) 6-45 U/L
20% increase) Oral Contraceptives (20% 5-30 U/L
Medications (e.g ethanol, phenytoin, decrease)
barbiturates, carbazepine, valproic acid)

9. LIPASE
ORGAN/ TISSUE SOURCE (per
isoenzyme, if present)
Exclusively secreted in the
pancreas
Methods/Assay
Diseases present if the enzyme is
+
ELEVATED Additional REFERENCE VALUES
Enzymatic Reaction/Pinciple of Assay
and its End
Cherry Crandall Method Most specific pancreatic
- Reference Method marker
- Hydrolysis of Olive oil after Lipemic spx
incubation for 24 hrs at 37 Acute pancreatitis - Reduction of
degree C and titration of Pancreatic duct obstruction lipase activity
fatty acids using NaOH. Tumors of Pancreas Opiates and morphine
Substrate: - Increase LPS 0-1.0 U / mL
- 50% olive oil (TRIOLEIN) Chronic Acute pancreatitis- acinar cell activity due to
End Product: degradation occurs which results to loss of its spastic effect
- Fatty acid amylase and lipase production. on the duodenal
musculature
and sphincter of
Oddi

4
5